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Dr. Andrew Rynne

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Exp 18 years

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Suggest treatment for high BP and Aortic insufficiency

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Dr. Rahul Tawde

General & Family Physician

Practicing since :1980

Answered : 1 Question

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Posted on Mon, 25 Aug 2014 in Brain and Spine
Question: Null, I forgot to mention, during deep thoughts and trances when not aware of my surroundings is when I stop breathing, without even inhaling at all. Plus I have high blood pressure, Aortic Insufficiency (Trace, minimum amount), Mitral Insufficiency (Trace, minimum amount), Tricuspid Insufficiency (Trace, minimum amount), and Diastole Heart Dysfunction (mild).Bilateral Middle Cranial Fossa Arachnoid Cysts is what it's actually called. Looked it up. It's larger on the left than the right.
doctor
Answered by Dr. Rahul Tawde 2 hours later
Brief Answer:
Apnic spells

Detailed Answer:
Hi, thanks for posting in the HCM.

From what you have written, I understand that you have Bilateral Middle Cranial Fossa Arachnoid Cysts, vulvular insufficiency and diastolic dysfunction.
You are a known hypertensive as well and you are having apnic spells.
But, I didn't find a question for which you need an answer. You haven't also specified the patient profile.

Hence, please reply with your specific query and fill up the patient profile as well.
I think you have echocardiography and brain imaging reports as well with you. Please also attach the scanned copies of all the available reports too, for better evaluation of the condition. Please also mention your regular medication list and whether you have any co-morbidity and medicine allergy in any follow up query.


If you are satisfied with my answer, please rate my answer. If you have any further query related to this, please write back.
In case you have any new query in future, you can directly ask me questions @ http://www.HealthcareMagic.com/doctors/dr-kaushik-sarkar/68460. I will try my level best to help you.
Regards,
Dr. Kaushik

Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Rahul Tawde 52 minutes later
What's Apnic? And that can happen when not even aware of it, without even inhaling; taking in breath before stop breathing (air is all exhaled out)? What can be done if someone witness this and it goes for a long period of time? Should they do anything; call 911, mouth to mouth, what? During these deep thoughts and trances that I get into; unaware of everything around me and don't even hear anything around me, when I briefly come back to being aware of everything and I catch myself not breathing, the second before I can get myself to breathe again, I instantly get back into deep thoughts and trances of unaware to reality without taking a breath. This happens periodically through it all until the deep thoughts and trances calms down and I can be active again. This even lasts for hours, too. I don't even gasp for air during these episodes, either. When I am aware and do get myself to start breathing again, I don't gasp for air. I just start as if I never even stopped in the first place. Is this something to take very seriously? I'm not sure how I can get these files over to you.

These episodes happens while I'm awake (forgot to mention that). And I don't have the files. My doctors has them.
doctor
Answered by Dr. Rahul Tawde 2 hours later
Brief Answer:
Absence Seizure and psychosis should be ruled out.

Detailed Answer:
Thanks for replying with more detailed history and specific queries.

Previously, I was thinking of apneic spells, which are breath-holding spells. But, now from a detailed history, I think you should consult a neuropsychiatrist to rule out two possibilities- Absence seizure and psychosis.

While absence seizure may present with similar symptoms, the duration for such "trances" are usually less than what you specified. Hence, hallucination should also be ruled out due to any form of psychosis, be it primary or secondary to some underlying disease.

You may need to have EEG done to rule out any form of seizure disorder. In case you are diagnosed with any seizure disorder, MRI of brain will be needed to rule out any underlying pathology.
Furthermore, I think you not only remain unaware of the surroundings during the episodes, you also remain unaware of your respiration. This condition is most probably "Stupor", which may occur due to numerous reasons including those I mentioned and any metabolic problem, encephalopathy, Schizophrenia, major depression, neoplasm of brain, medications etc.

As you have not provided the details of your patient profile e.g. age, gender etc, neither the investigation reports and list of your current medications, it would not be possible to come to a specific diagnosis with only this information.

But, you should consider this condition as an emergency and immediately consult a neuropsychiatrist for further evaluation.

Hope you are satisfied with my answer. If you think I have satisfactorily resolved your query, please rate my answer. If you have any further query related to this, please write back.
In case you have any new query in future, you can directly ask me questions @ http://www.HealthcareMagic.com/doctors/dr-kaushik-sarkar/68460. I will try my level best to help you.

Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Rahul Tawde 9 minutes later
I see a neurologist and I'm diagnosed with strike. I have XXXXXXX strokes.
doctor
Answered by Dr. Rahul Tawde 24 minutes later
Brief Answer:
Stroke is the underlying cause here.

Detailed Answer:
Hi,
Thanks a lot for your prompt reply and a valuable information.
In stroke patients stupor can definitely happen. Even the risk of developing seizure disorders are also increased in stroke. Some form of psychosis or other mental disorders e.g. major depression may occur as a sequelae.
I hope your neurologist have already given you medications to prevent seizure disorder. However, stupor can occur as a direct sequelae of stroke and also suggest decline in cognitive function.
Regarding, mini-strokes, they are actually temporary diminish in blood supply in some part of your brain. If you have not yet developed a stroke, these are the warning signs before a major one.
1. Please follow your neurologist's advice strictly
2. Avoid high calorie diet and extra salt, increase fiber intake.
3. Strict control of your blood pressure and plasma glucose levels are crucial.
4. If possible, have regular exercise session or walking.
5. Consult your neurologist or a neuropsychiatrist for evaluation for any requirement of medications that stimulate cognitive function.
Finally, please don't worry much about your current problem for now you know the underlying cause of that. Following above advice would certainly help you to prevent any further cognitive decline and if proper treatment guidelines are strictly followed there is definite scope for improvement.
Hope you are satisfied with my answer. If you think I have satisfactorily resolved your query, please rate my answer. If you have any further query related to this, please write back.
In case you have any new query in future, you can directly ask me questions @ http://www.HealthcareMagic.com/doctors/dr-kaushik-sarkar/68460. I will try my level best to help you.
Regards,
Dr. Kaushik
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Rahul Tawde 2 hours later
What's Stupor? What's Sequelea? When I was a baby, I had seizures due to blood in the CNS. This was during infancy through blunt force trauma to the head. No, I'm not on meds for seizures. I only take Aspirin 81 mg for stroke. I also have a narrow blood vessel in the brain that can bust at any time.
Can I send you the three images of the brain through email instead? I'm unable to get all the documents. I could just get theses images through email. I can forward them to you. It's from a neurosurgeon. Would this help you somewhat? How is this related to stop breathing without even realizing it while I'm awake and into deep thoughts and trances?

Note: This is not my neurologist who has sent me the MRI images. I sent him copies from my actual Neurologist, asking him for more info that my actual neurologist hasn't provided me. And I'll forward you the emails he has sent me in answering my questions I had asked him that pertains to the brain...

I can only forward them all to you. I can't get them onto this website. Is that okay? I need to know before I send them to you.
doctor
Answered by Dr. Rahul Tawde 13 hours later
Brief Answer:
Please send to YYYY@YYYY

Detailed Answer:
Hi, thanks for your reply.
It will be great if you send me the reports. You can send them to YYYY@YYYY with Sub: ATTN 'Dr Kaushik Sarkar'. You please send me all the relevant documents in this mail id.

Regarding "Stupor" I can say, it is a condition due to severe decline in cognitive function and consciousness level, wherein the patient is unaware of his environment or surrounding.
"Sequelae" means consequences or result of a disease.
I wanted to mean " stupor can occur as a direct consequence of stroke and also suggest decline in cognitive function."
And I would again clarify you that this is not possible that you are not having your respiration. The only thing that can happen is that you are unaware of your breathing or respiration. And that can occur in the state of "stupor".

Hope you are satisfied with my answer. If you think I have satisfactorily resolved your query, please rate my answer. If you have any further query related to this, please write back.
In case you have any new query in future, you can directly ask me questions @ http://www.HealthcareMagic.com/doctors/dr-kaushik-sarkar/68460. I will try my level best to help you.



Above answer was peer-reviewed by : Dr. Ashwin Bhandari
doctor
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Follow up: Dr. Rahul Tawde 27 hours later
When I completely stop breathing while still conscious but unaware of not breathing, can someone do mouth to mouth if I don't get started to on my own in certain amount of time? And if so, how long before they should? I don't know how long it lasts when that happens, but I do know it lasts for some time, though.
doctor
Answered by Dr. Rahul Tawde 5 hours later
Brief Answer:
You don't need any resuscitation

Detailed Answer:
Thanks for asking again.

However, as I have told you previously, in the condition you described previously, you definitely remain conscious. But, despite being conscious you remain indifferent of yourself and your surrounding because you are unaware of them.
In very simple, non-medical terms, I can say, though you think that you are not breathing, you actually do breath at that time. But, you remain unaware of your breathing efforts. So, you don't need any external support for breathing or respiration. Hence, no resuscitation measures like mouth to mouth breathing will be required. Please understand that this is your brain which remains not aware of your breathing, despite the fact that you actually breath, at the time of "Stupor"

Furthermore, it is also not possible for you to determine the duration in which you remain in that status.

Lastly, if you are staying alone, without any support, I think a domestic help or a daily care-giver will be required to stay with you.
Hope you are satisfied with my answer. If you think I have satisfactorily resolved your query, please rate my answer. If you have any further query related to this, please write back.
In case you have any new query in future, you can directly ask me questions @ http://www.HealthcareMagic.com/doctors/dr-kaushik-sarkar/68460. I will try my level best to help you.

Above answer was peer-reviewed by : Dr. Vaishalee Punj
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